END OF LIFE STUDIES — For Doctors and Everyone Else

FYI–doctors are not particularly good at dealing with death and dying. 

That may surprise some.  There may be an assumption that doctors are somehow more familiar with death, perhaps trained to deal with all its implications and ramifications than the average person and, therefore, more comfortable discussing and dealing with it–but for the most part, this isn't the case. 

There have been attempts by some medical schools to introduce the topic and encourage open discussion.  But I haven't seen much evidence among my colleagues that it has worked.

Doctors are trained to diagnose, treat and "defeat" disease states.  Death is seen as the ultimate enemy. We are not comfortable with it.   Doctors are trained to be defensive about death.  Society has raised expectations of health care to such an extent that death is viewed as the consequence of medical mistakes, a potential  malpractice case.  Our litigious society, fueled by avaricious attorneys has inflamed the issue of death to such an extent that doctors overdo defensive practices (despite Obama's clams).

Doctors are afraid to openly discuss with the patient and their family when  further aggressive treatment will only cause suffering and not change anything.  Palliative approach or even Hospice consultation should be suggested by doctors.  Rarely does that occur.

Doctors will often insert their own personal/religious beliefs into the discussion with families about end of life care.   Some of the motivation, sad to say, may be financial.  Instead, they should allow family members to address these issues with their loved ones who may, themselves, be conflicted about the best approach.  Doctors should be open to discussing medical realities.  Offering false hopes by suggesting risky testing or therapies is inappropriate.  Honesty is needed as well as being open to answering family concerns.

I have been consulted about inserting endoscopic feeding tubes (PEGs) in patients who are at the end of life.  Family members worry that their loved ones are "hungry" and starving when they stop eating.  I point out that this is the natural consequence of the body "shutting down".  Force feeding would actually make their loved ones uncomfortable.  It will change nothing.

 

The issue becomes one of judging the quality of the individual patient's life and their prognosis.  The patient's wishes should be reviewed.  Family members should not attempt to change advanced directives because it makes them uncomfortable.

I often advise families to do what is in their loved one's best interest, not their own.  They may want them to continue to stay alive, but at what cost?  Quality of life IS important.  When it is gone it is time to offer comfort and compassion.

Palliative care committees need to proliferate.  The public needs to face end of life issues with open dialogues involving religious leaders, ethicists, physicians, social workers and well known cultural icons.

Death should not be regarded as the unspoken enemy.    It depends on the particular situation.  A sudden death of a young otherwise healthy individual is always tragic. But for those been blessed with relative longevity and facing a progressively worsening medical condition,  death represents the end of suffering and the ultimate fate of all of us.

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